Healthcare Provider Details

I. General information

NPI: 1225186471
Provider Name (Legal Business Name): SAM'S CLUB PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2007
Last Update Date: 07/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4373 CORUNNA RD
FLINT MI
48532-4152
US

IV. Provider business mailing address

4373 CORUNNA RD
FLINT MI
48532-4152
US

V. Phone/Fax

Practice location:
  • Phone: 810-733-0741
  • Fax: 810-733-0997
Mailing address:
  • Phone: 810-733-0741
  • Fax: 810-733-0997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301007744
License Number StateMI

VIII. Authorized Official

Name: MS. SARAH B BROOKE
Title or Position: PHARMACY MANAGER
Credential:
Phone: 810-733-0741